A_Tab_1d_SOW_Draft.pdf

OROTHOTICS/PROSTHETICS PRACTITIONER

PERFORMANCE BASED WORK STATEMENT

I. GENERAL INFORMATION

A. Introduction

FCC Butner requires the services of an Orthotics/Prosthetics practitioner for inmates at the Federal Correctional Complex (FCC) Butner, North Carolina. The FCC includes the Federal Medical Center (FMC), the Federal Correctional Institution (FCI), the Federal Prison Camp (FPC), and the Low Security Correctional Institution (LSCI). This will be a contractual arrangement between the contractor and the Federal Government and does not constitute an employer/employee relationship. The contractor must accomplish a specific result without supervision, according to the work statement, within the contractor’s own determination. The contractor is required to complete all tasks outlined in the Statement of Work by applying whatever methods are deemed appropriate, consistent with professional standards and BOP policy. Payment will be based on the provision of an end product or the accomplishment of a specific result. The contractor will not be subject to Government supervision, however, monitoring will be provided by the Contracting Officer’s Representative (COR). Due to the secure nature of the institution and the requirements set forth for entry and inmate contact, and in order to maintain continuity of care for the inmate population, a single Orthotics/Prosthetics provider will be selected to provide these services “in house”.

B. Background This non-personal service requirement is due to the FMC Rehabilitation needs that are not included in the current comprehensive medical contract under separate contract award.

C. Scope The overall purpose of this non-personal service contract is to provide approximately 72 hours per year of Orthotics/Prosthetics services to FCC Butner. The contractor will be responsible for providing professional medical services in the field of orthotic/prosthetic appliance application and/or footwear installation and repair as deemed necessary.

II. WORK REQUIREMENTS

A. Technical Requirements The contractor is responsible for the provision of the services listed below:

Provide professional medical services in the field of orthopedic appliance application and/or orthopedic footwear installation. Applications may include upper extremity, lower extremity, individual inner/outer footwear needs, and any other custom appliances as determined by the Clinical Director. Please note that some orthotic footwear needs, such as relatively simple insert needs will be provided by BOP employees employed at either FMC Butner or elsewhere. The contractor shall supply the following: (annual estimated quantities -no guaranteed minimum quantity):

· Orthopedic Footwear: i.e., HCPCS codes L3225 through L3251 Estimated Quantity: 20

· Below The Knee Prosthetic: i.e. HCPCS codes L5620, L5540, L5301, L5637, L5655 and L5668 Estimated Quantity: 4

· Above the Knee Prosthetic: i.e., HCPCS codes L5624, L5590 and L5321 Estimated Quantity: 2

· Lower Limb -Ankle-Foot: i.e. HCPCS codes L1900 through L1990 Estimated Quantity: 28

· Lower Limb Knee: i.e., HCPCS codes L1800 through L1885 Estimated Quantity: 15

Note: The above stated quantities and L codes listed are only provided as an estimate of need and for purposes of responding to the solicitation. In reality, these and other L codes not listed may be utilized during the term of the agreement.

The contractor shall also perform repairs to prosthetic devices as deemed necessary by the Hospital Administration.

B. General Experience The contractor must have a minimum of one-year experience performing Orthotics/Prosthetics skills. The contractor must have the ability to work with an inmate population from a variety of cultural, regional, racial and ethnic backgrounds. Experience working with an inmate population is preferred, however, is not required.

C. Professional Certification The contractor must be certified as an Orthotics/Prosthetics professional from an accredited school and have one year experience in this field. The contractor is required to indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance. The contractor must maintain malpractice insurance coverage of $1,000,000.00. The offeror shall provide a copy of all the above stated qualifications with their quote to the contracting officer. Contractor shall be a Medicare provider that is not under any sanctions nor have any administrative or criminal remedies or penalties pending.

D. Supplies With the exception of specialized supply items incorporated into the Health Care Procedure Coding System (including all so-called “L code” items), all clinic supplies that the contractor may routinely need will be provided by FCC Butner. These supplies will normally include any materials needed to perform the services covered under this contract. All medical records remain the property of FCC Butner in accordance with the Privacy Act of 1974.

III. SUPPORTING INFORMATION

A. Security Contractor agrees to adhere to all regulations prescribed by the institution for safety, custody, and conduct of inmates. The contractor shall attend a 4 hour orientation program prior to assuming their full duties within the institution.

Provision of services under this contract will require frequent and unsupervised contact with inmates. Contractor will not be responsible for the administrative management of inmates other than to ensure that those inmates involved in activities within the contractor’s scope of work shall abide by all rules in effect to ensure their safety and well being.

Unless individual waivers are obtained under procedures outlines in Program Statement 4100.02, dated May 3, 1989, the following investigative procedures will be applied to contract employees working under the terms of this the proposed contract.

A. NCIC Check (National Crime Information Center) B. DOJ-99 (Name Check) C. FD-258 (Fingerprint Check) D. Vouchering of employees over the past five years E. Law Enforcement Agency Checks F. SF-171 (Personal Qualifications Statement) G. OPM-329-A (Authority for Release of Information) H. Urinalysis Test for detection of drug and marijuana usage.

B. Place of Performance The services will be performed at FCC Butner, North Carolina under the direction of the COR.

C. Period of Performance This will be a firm fixed price, indefinite delivery, requirements contract that is based upon valid L Code billings via the prior mentioned Medicare based payment methodology. The period of performance will be for a base period and four one-year option periods. The work schedule will consist of TWO clinics per month that will last an estimated projected four hours. The total projected clinic hours will be approximately 96 hours per year. The work schedule will include at least one 15 minute break period. Any deviation from this schedule shall require the prior approval of the COR. Hours of work must be during normal work days and hours, Monday through Friday, 7:30 a.m. - 4:00 p.m., excluding official Federal Government holidays. While the growth in service needs over the term of the contract are projected to remain constant, should there be a substantial increase in patient referrals to FMC Butner it is possible that there could be a corresponding substantial increase in demand for orthotic/prosthetic services over and above the projections included in this Statement of Work. The successful offer must be able and willing to meet any now unforseen additional workload during the contract term

D. Special Considerations The contractor may be required to submit to testing for or provide evidence acceptable to the Clinical Director of recent testing for Tuberculosis or other communicable diseases as might be required by the Clinical Director. Failure to submit to testing for, or provide acceptable evidence of recent testing for or immunity to, selected communicable diseases shall be grounds for denying access to inmates and may result in termination of the contract.

All hours worked must be documented by the contractor by showing the total number of hours worked on the “Log of Consultants Visit” form with each entry being signed and dated by the contractor. Contractor shall immediately inform the COR in writing of any claims made, lawsuits filed or other legal actions that might occur as a result of the contractor’s practice of his/her profession, not only as a result of services performed at a BOP facility, but also those involving any setting in which services of a nature substantially similar to services contracted for by FCC Butner are being performed.

Contractor shall immediately inform the COR in writing of any adverse action taken by any State regulatory body involving certification. This includes, but is not limited to, suspensions, revocations, and restrictions on practice or prescribing and reprimands.

E. PRICING METHODOLOGY

All price proposals shall be calculated from a benchmark utilizing Medicare reimbursement methodologies. The submitted proposal must include this methodology. For each category of service to be provided, Offerors should provide an amount equal to or propose a variance from the benchmark Medicare rate in the form of a discount from or a premium to Medicare rates established by the Centers for Medicare & Medicaid Services.

Medicare Part B Physician Services: The Medicare benchmark to be utilized for all physician services covered by Medicare Part B shall be those rates established in the most current Medicare Part B Fee Schedule for the Raleigh/Durham and Oxford, North Carolina service areas. The benchmark charges shall be those established for participating providers.

The rates established in the resulting contract shall not be construed as participation in the Medicare program; rather, contract rates will merely be equated to Medicare rates of reimbursement. This pricing methodology is not intended to be restrictive of any offer. If during the term of the contract it is determined that a necessary contract deliverable is not covered by Medicare reimbursement methodologies, a separate rate shall be negotiated for such deliverable(s).

During the course of the contract, the dollars charged per unit of service might change as Medicare payments change for North Carolina providers. However, the percentage of Medicare payment methodology will not. As an example, by a provider stating he will accept Medicare assignment payment methodology as payment in full (100% of Medicare payment methodology) for all services provided, this means that methodology must be used for all billings directly related to orthotic/prosthetic services provided at FMC Butner and not just for the example L codes discussed elsewhere in the Statement of Work. FMC Butner can not accept electronic billing for services rendered. All billings for services rendered must be received at the FMC Business Office within 90 days of service or the potential financial obligation will be null and void.

F. Total

Use workload projections included in this Statement of Work and Medicare L code rates for North Carolina providers in effect as of August 1, 2002.

Base Period Medicare %_______ total dollars______

Option Year 1 Medicare %_______ total dollars______

Option Year 2 Medicare %_______ total dollars______

Option Year 3 Medicare %_______ total dollars______

Option Year 4 Medicare %_______ total dollars______